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Pregnancy's Mysifying Emotions

The Hartford Courant - September 12, 1995
by Mary Jo Kochakian

Pregnancy is lovely, appalling, satisfying, disturbing, tedious, vivid, mystifying, clarifying.

Even first-timers usually expect ups and downs. What many women do not anticipate, though, is that it can go beyond the normal: pregnancy and postpartum can be times of serious emotional trouble.

"The recognition of illness related 'to childbirth goes back to the 18th century," says Canadian psychiatrist Shaila Misri. The problem was thought to be poisons affecting the brain.

"Mental or psychiatric illness associated with anyone is still full of stigma," Misri says. "But when it's associated with a time when you're supposed to be happy," there is even more stigma, more denial.

"I had a new patient today, 1/2 months pregnant, acute panic attacks," Misri said in an interview. "She wakes up at 2 in the morning, drenched with sweat heart beating. She goes to her doctor, and her doctor says, 'You don't need to see Dr. Misri.' " The patient told her it look repeated visits with and calls to the doctor to convince him she needed treatment. "And it's 1995."

Misri specializes in treating women for problems related to reproduction. She is a clinical professor of psychiatry and obstetrics-gynecology at the University of British Columbia, Vancouver, a director of reproductive psychiatry programs at two hospitals, and author of '"Shouldn't I Be Happy?" (Free Press, $23).

"Most women have questions, concerns and worries as they face pregnancy." she writes. "And for the most part, these are well within the range of normal and relatively easy to deal with ... Worrying about the results of a test or how your childless friends will relate to you is perfectly normal: It's only when you find it impossible to shake a particular anxiety and your worry upsets your routine, or when one sleepless night becomes weeks, of insomnia, or an occasional crying jag becomes a permanently hopeless mood that the situation has become abnormal and help is called for."

But because of the many changes and stresses — physiological, psychological, social — that pregnancy brings, a significant number of women do have trouble, Misri says.

Particularly if a woman has a personal or family history of emotional problems or psychiatric illness, she should be mindful it could happen to her, Misri says, and keep her doctor informed.

In her book she reports on treating pregnant women with depression, anxiety disorders, eating disorders, obsessive-compulsive and other disorders, and women experiencing miscarriage, birth tragedies or infant death. Even breastfeeding issues can be serious. It's essential women know mental illness can be treated and alleviated in pregnancy, she says.

Depression is the most common problem. Major depression during ' pregnancy affects 4 percent to 12 percent of women, she writes. (Clinical postpartum depression affects about 10 percent of women.) Women with a history are at higher risk for recurrence. More knowledgeable women with access to care can work with their physicians and get treatment if needed. Less knowledgeable women could find themselves "having feelings of hopelessness, the feeling of a 'black hole,' and will not seek help because they don't know what is going on," she says. "The good news about depression is a lot of depressions will disappear in six months to a year. But the bad news is it has done a lot of damage." Bonding between mother and baby takes place in the first months. "If a woman is depressed and not able to connect with her child, it can be very tragic," Misri says. "I've had patients of mine who told me two or three years later they have no feelings for the child they had when they were depressed."

But depression "is not a contradiction to successful pregnancy and childbirth or being a successful mother," Misri says. A woman who has suffered a serious postpartum depression, for example, needn't abandon hopes for another pregnancy.